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The control of bleeding and the determination of the appropriate amount of bone to resect are two common technical difficulties in performing arthroscopic subacromial decompression. We describe a technique that simplifies the procedure while providing more precise bone resection and contouring. First, the coracoacromial ligament is released by sectioning the anterior margin of the acromion. Bleeding is minimized with this technique because the coracoacromial ligament itself is not being cut, but rather its bony attachment is resected. An acromioplasty is then performed with the arthroscope in the lateral portal and the burr in the posterior portal. The shank of the cutter is rested against the posterior lip of the acromion, which acts as a fulcrum. The tip of the burr is placed at the deepest point of the concavity of the acromion. Bone is resected by sweeping the cutter from lateral to medial and progressing anteriorly while maintaining the angle of the burr, using the angle of the posterior acromion as a guide. In this way the appropriate amount of bone is automatically resected, resulting in a flat acromion which is tapered anteriorly and has a smooth transition to normal bone posteriorly.
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The technique described in this article will be demonstrated in a forthcoming Video Supplement to Arthroscopy.
© 1992 Arthroscopy Association of North America. Published by Elsevier Inc.